The impact of traditional versus hotspot-driven anatomy practical assessment on student cognitive processes

Practical examinations are commonly implemented to assess student knowledge of human gross anatomy. The in-person timed cadaveric practical is a classic assessment tool; however, several new approaches, like online or oral practical assessments, have become increasingly popular in recent years due to time, space, and/or financial constraints. These formats assess working memory, and thus, cognitive functioning. Various tasks such as recognition and recall are employed in memory retrieval. At the University of South Carolina School of Medicine Greenville (USCSOMG), we utilized two different practical formats to assess student memory of similar anatomy content: traditional in-person practical (IPP) and virtual hotspot practical (HSP). In the HSP exams, students selected a particular area of interest in an image based on a question prompt. During the same testing session, first-year medical students took HSP and IPP examinations covering comparable content at four distinct time points. Exam performance was consistently higher on HSP examinations compared to IPPs (mean HSPs 86.54% vs. IPPs 83.95% [p < 0.001]). However, IPP examinations were found to be significantly more discriminating (IPP items = 0.24 vs. HSP items = 0.20 [p = 0.01]) and reliable (IPP = 0.79 vs. HSP = 0.52 [p < 0.001]) at distinguishing strong students from weak students. These differences likely stem from the varying cognitive demands: IPPs emphasize recall, considered more challenging than recognition tasks central to HSPs. Based on these results, we recommend that instructors carefully consider the intended cognitive process assessment when selecting the format of anatomy practicals.